Clinical research on the perioperative hemodynamic changes recorded by MostCare/PRAM system in the off-pump coronary artery bypass grafting surgery / 中国胸心血管外科临床杂志

@#Objective    To investigate the perioperative hemodynamic changes of off-pump coronary artery bypass grafting (OPCABG) patients monitored by pulse recorded analysis method (MostCare/PRAM devices) and its relationship with the prognosis. Methods    A total of 89 patients who underwent OPCABG from October 2016 to January 2017 in Beiijng Anzhen Hospital were included, including 53 males and 36 females aged 60.50±8.40 years. The hemodynamic changes were recorded. The patients were divided into two groups (a major adverse cardiovascular events group and a stable group) according to whether major adverse cardiovascular events occurred or not. The difference of hemodynamic changes between the two groups was analysed. Results    The mean percentage increases of stroke volume (SV) in the passive leg raising (PLR) test before opening chest and after chest closure were 23.00%±3.20% and 29.40%±3.70%, respectively. Hemodynamic data were analysed seven times, namely, anaesthesia, opening chest, heparin administration, coronary artery bypass grafting, protamine administration, thoracic closure and after operation. SV was significantly decreased during above periods, while systemic vascular resistance index (SVRI) was significantly increased. Cardiac circle efficiency (CCE) and maximum pressure gradient (dP/dT) were decreased after anaesthesia, and decreased to the lowest value during the procedure of bypass grafting, and then they began to increase gradually after the manipulation of bypass grafting was finished. Stroke volume variation (SVV) and pulse pressure variation (PPV) were slightly decreased during anaesthesia, then increased significantly through the whole surgery. Major adverse cardiovascular events occurred in 9 patients and 4 of them died. The basic mean values of SVRI, SVV and PPV of patients in the major adverse cardiovascular events group before opening chest were significantly higher than those of patients in the stable group. There was no significant difference in the mean values of CCE, dP/dT or SV between the two groups. There was no significant correlation between the prognosis and the mean values of SVRI, SVV, PPV, CCE, dP/dT or SV. Conclusion    The hemodynamic indexes are not stable, thus, it is necessary to monitor the perioperative hemodynamic changes of OPCABG patients timely by MostCare/PRAM device and adjust treatment measures accordingly.

Long-term outcomes of patients with unprotected left main coronary artery disease post revascularization / 中华心血管病杂志

<p><b>OBJECTIVE</b>To compare the long-term real-world outcomes of consecutive patients with unprotected left main coronary artery disease (ULMCA) underwent percutaneous coronary intervention (PCI) with drug-eluting stents (DES) and coronary artery bypass grafting (CABG).</p><p><b>METHODS</b>Consecutive patients with ULMCA (defined as stenosis ≥ 50%) undergoing DES implantation or CABG between January 2003 to July 2009 in Beijing Anzhen Hospital were enrolled. The follow-up period extended through August 2013. The end points of the study were death, cardiac death, repeat revascularization, myocardial infarction (MI), stroke, the composite of cardiac death, MI or stroke and MACCE (major adverse cardiac and cerebrovascular events, the composite of cardiac death, MI, stroke or repeat revascularization).</p><p><b>RESULTS</b>From January 2003 to July 2009, 922 ULMCA patients were enrolled in this study (465 PCI patients, and 457 CABG patients). The median follow-up was 7.1 years (interquartile range 5.3 to 8.2 years). The crude relative risk was as follows: overall death rate (13.0% (41/465) vs. 22.1% (72/457), P = 0.009), stroke rate (5.8% (11/465) vs. CABG 18.9% (46/457), P < 0.001) were significantly lower whereas the rate of repeat revascularization (32.3% (110/465) vs. CABG 19.2% (58/457), P < 0.001) was significantly higher in PCI group than in CABG group. MI rate was similar between PCI and CABG group (13.9% (33/465) vs. 6.7% (26/457), P = 0.196). MACCE rate was also similar between the 2 groups (42.9% (145/465) vs. 42.5% (142/457), P = 0.122). After multivariate adjusting, there was no significant difference in rates of death, MI and a composite of serious outcomes (cardiac death, MI, or stroke) between the 2 groups. Rates of MACCE were significantly higher in the PCI group (P = 0.009) due to increased rate of repeat revascularization (P < 0.001). However, stroke rate was still significantly higher in CABG group (P = 0.001) after multivariate adjusting.</p><p><b>CONCLUSION</b>During a follow-up up to 8.2 years, the survival rate is similar between the PCI and the CABG group in patients with ULMCA disease. The rate of repeat revascularization is significantly higher and stroke rate is significantly lower in the PCI group compared to CABG group.</p>

The management and risk factors of pericardial effusion after cardiac surgery / 中华胸心血管外科杂志

Objective We aimed to recent experience at our hospital in the diagnosis and treatment of pericardial effusion after cardiac surgery and to identify risk factors for its development.Methods We searched our hospital for patient who had cardiac surgery with cardiopulmonary bypass from January 2002 through December 2010.For patient with pericardial effusion,medical records were reviewed to evaluate its manifestations and management.To identify risk factors for effusion,patients with effusions were compared with patients without effusions.All patients had routine postoperative echocardiographic examination.Results Of 22462 patients identified,509 (2.3％) had pericardial effusion.Compared with patients without pericardial effusion,ages,sex,cardiac function and so on were no significant( P ＞ 0.05 ).Body,valve cardiac diseases,and cardiopulmonary bypass time and so on were significant ( P ＜ 0.05 ).Among 509 patients with pericardial effusion,262 patients (51.4％) of whom had specific symptoms.Clinical features of tamponade were documented in 51 patients( 10.1％ ).Pericardial effusions were evacuated by echocardilgraphy-guided pericardiocentesis ( n =27,10.3％ ) or surgical drainage ( n =15,5.7％ ).Pericardial effusion resolved after left thoracocentesis for pleural effusion in 5 patients ( 1.9％ ) ; The Other patients with pericardial effusion were treated conservatively.Indeperdent risk factors for pericardial effusion were large body,valve cardiac operations,and prolonged cardiopulmonsry bypass.Conclusion In our study,pericardial effusion occurred in 2.3％ of patients,and symptoms were nonspecific.Several factors,mainly related to preoperative characteristics and type of operation,predispose patients to effusion,echocardiography-guided pericardiocentesis is effective and safe in these patients with pericardial effusion.

Comparison of the long-term graft patency of on-pump versus off-pump coronary artery bypass grafting / 中华胸心血管外科杂志

Objective Off-pump coronary artery bypass grafting (OPCAB) is used more widely in recent years in China. However, there is an argument on benefits and risks of off-pump surgery. Many studies shown that OPCAB had more benefits in short-term outcomes than conventional coronary artery bypass grafting(CCABG). But evidences from other studies suggested that OPCAB resulted in less long-term graft patency as compared with on-pump surgery. This study examined the longterm graft patency of OPCAB and CCABG performed by one surgeon. Methods 50 patients who had received surgical revascularization by a surgeon for more than 5 years were reviewed, 25 patients received conventional coronary artery bypass grafting ( group 1 ) and 25 patients received OPCAB ( group 2). All patients had angiograms for compareing the graft patency between the two groups. Results Among 25 patients in group 1,21 were male and 4 were female. The mean age of patients at surgery was (55.4 ±8.9) years. 15 cases had unstable angina, 16 patients had old myocardial infarction and 6 cases had diabetes.The ejection fraction (EF) was 0.58 ±0.14. The mean number of bypasses per patient was 3.32 ±0.63. Mean duration of operation was (3.58 ± 0. 82) hours. Mean follow-up duration was ( 86.52 ± 12.48) months. 83 grafts were evaluated for patency ( open vs. closed) and were graded by Fitzgibbon as grade A ( excellent graft), B ( impaired graft, with a stenosis of ≥50%, or a diameter less than 50% of the grafted artery), or O ( completely occluded). The graft patency was 73.49%, 61grafts were graded as Fitzgibbon A, 6 grafts as Fitzgibbon B and 16 grafts as Fitzgibbon 0. 25 patients were in group 2, 21males and 4 females. The mean age of patients at procedure was (58.2 ± 9.09) years, 11 patients had unstable angina, 13 patients had old myocardial infarction and 6 cases had diabetes. The ejection fraction (EF) was 0.59 ± 0. 14. Conclusion No 2011.03.013 difference in long-term graft patency was identified between on-pump and off-pump coronary artery bypass grafting. Off-pump oronary artery bypass grafting preformed by an experienced surgeon may gain similar long-term graft patency to that of conventional bypass.

Thoracic endovascular aortic repair of chronic type B aortic dissection in 84 patients / 中华胸心血管外科杂志

Objective The optimal treatment for chronic type B dissection remains controversial. The purpose of this study was to report early and mid-term results of thoracic endovascular aortic repair (TEVAR) of chronic type B aortic dissection. Methods Methods From June 2001 to September 2007, 84 patients with chronic type B aortic dissection received TEVAR. The time between onset of dissection and TEVAR was (13.9 ± 22.0) months (ranged 1 - 120 months). All patients were followed for 6 - 86 months [mean (33.2 ± 19.2) months]. Results The entry tear was completely sealed in 77 cases ( 91.7% ) during TEVAR. The incidence of incomplete seal was 8.3%. One-month mortality was 1. 2%. One patient had retrograde type A dissection 1 month after operation. Four patients received a second TEVAR during follow-up :3 for endoleaking and 1 for newly formed intima tear. Seven patients (8.3%) died during follow-up: 3 thoracic aorta rupture due to endoleaking, 1 abdominal aorta rupture caused by continuous dilation of the abdominal aorta, unrelated to aortic dissection deaths in 2 and 1 died of unknown cause. The Kaplan Meier actuarial survival curve showed a 7-year survival rate of 84.4%. Conclusion Early and mid-term results showed that TEVAR was effective in treating chronic type B aortic dissection. Endoleak was the main cause of death during follow-up. With increasing of physician's experience and refinement of the stent-graft, results are likely to improve in the future.

Surgery treatment of ischemic mitral regurgitation / 中华胸心血管外科杂志

Ovbective To report our experience of surgical treatment for ischemic mitral regurgitation. Methods From April 1998 to November 2003,44 patients with ischemic mitral valve regurgitation underwent mitral valve plasty (MVP,30) or replacement (MVR,14) and CABG. There were 7 cases with mild-moderate MI,24 with moderate MI,13 with severe MI before operation. The procedures of MVP included: commissural annuloplasty in 12,posterior ring annuloplasty in 15,Carpetier's ring annuloplasty in 2,qurdrangular valvulectomy in 4,cordal transplantation in 1,and "double-orifice" technique in 1. Mechanical valves were implanted in 12 MVR patients and biological in 2. Results There were 7 operative deaths (15.9%). The causes of death were heart failure in 4 cases,arrhythmia in 2 and strode in 1. 33 patients were followed up to a mean period of 20 months. There was 2 late death. 29 patients were in NYHA functional class I and II,3 in class III. UCG examination for MVP patients showed no pr trivial MI in 12 patients,mild in 5,moderate in 2 cases. LV size decreased significantly [(62.3?6.3) mm vs. (54.3?7.1)mm]. There was 1 case of perivalvular leak in MVR group. Statistical analysis showed severe preoperative symptom,significantly enlarged LV size and severely depressed LV function were risk factors of operative death. Conclusion Coronary artery desease with ischemic mitral regurgiatation should be treated aggressively. Operative technique should be based on valve pathology. Valve repair should be considered if possible.

Clinical experience of coronary artery bypass graft on the left main coronary stenosis in 225 cases / 中华胸心血管外科杂志

Objective: To study the efficacy and clinical experience of surgical treatment in the patients with left main coronary artery stenosis. Methods: Two hundred and twenty-five patients with left main stenosis (LMS) underwent coronary artery bypass graft (CABG) between January 1999 and June 2003. The average age was 63.4 years. The left ventricular ejection fraction was ≤30% in 11 patients. Emergency surgical revascularization was performed in 6 patients because of hemodynamic instability in whom 3 were treated with intraaortic balloon pump (IABP) before surgery. Seventy-six patients underwent coronary artery revascularization with conventional cardiopulmonary bypass, 149 without pump (OPCAB), and 5 patients were converted to CPB. Thirteen patients accepted total arterial revascularization and 3 total venous conduits. Results: The mean preoperative stay was 2.3 days and number of distal anastomoses was 2.95/pt. There were 13 postoperative deaths with a mortality of 5.78%. Conclusion: The presence of left main stenosis is an independent predictor of postoperative mortality after coronary bypass grafting. CABG at presents is the first choice for such patient and is a safe and effective method.

Minimally invasive direct coronary artery bypass grafting: Report of 33 cases / 中国微创外科杂志

Objective To discuss the feasibility and safety of minimally invasive direct coronary artery bypass grafting (MIDCABG). Methods A total of 33 patients underwent small incision, off-pump, single-vessel direct coronary artery bypass grafting in this hospital from March 2001 to September 2003. Left anterior small thoracotomy was adopted in 14 patients, whereas partial midline sternotomy was conducted in 19 patients. The left internal mammary artery was anastomosed to the anterior descending artery in 31 patients, construction of the aorta root-anterior descending artery anastomosis using the great saphenous vein was carried out in 1 patient, and the right gastroepiploic artery was anastomosed to the posterior descending artery in 1 patient. Results The operative mortality was a zero. The intraoperative blood loss was 163?120 ml, and the postoperative drainage, 193?169 ml. The assisted respiration time after operation was 6 4?5 5 hours and the duration in ICU was 17 8?4 4 hours. Follow-up for 14 7?7 4 months found no deaths. Conclusions MIDCABG is a safe and reliable procedure, offering minimal invasion, less blood loss and fewer complications.

Pathological study of dilated cardiomyopathy / 中国病理生理杂志

AIM: To study the pathological features of the dilated cardiomyopathy and the mechanisms involved. METHODS: The left ventricular myocardium specimens were obtained from 8 patients with dilated cardiomyopathy by BATISTA. The morphological changes was examined macropathologically and histopathologically. RESULTS: The dilated cardiomyopathy from 8 patients can be classified into two types macropathology. One of them showed hypertrophy of left ventricular wall and the other showed fatty infiltration on myocardium of the left ventricular. In the first type, swelling of the endothelial cells as well as luminal stenosis even occlusive of small arteries and arterioles were observed in the study. Electronical microscopical examination showed that there were a lot of homogeneous secretory granules in the endothelial cells. CONCLUSION: These results suggested that the secretory granules might be from the damaged myocardial cells and entered into the adjacent endothelial cells. The pathological changes mentioned above could aggravate the ischemia of myocardium. At the same time, the vicious cycle make the pathological changes more serious. Further study should be made to confirm the nature of the secretory granules.